Summary of findings 2.
Calcineurin inhibitors versus IV cyclophosphamide
| Interventions for idiopathic nephrotic syndrome in children | ||||||
| Patient or population: idiopathic steroid‐resistant nephrotic syndrome in children Setting: paediatric nephrology clinics Intervention: calcineurin inhibitor (CNI) Comparison: IV cyclophosphamide (CPA) | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with IV CPA | Risk with CNI | |||||
| Remission at 3 to 6 months: complete or partial remission | Study population | RR 1.98 (1.25 to 3.13) | 156 (2) | ⊕⊕⊝⊝ LOW 1 2 | ||
| 397 per 1000 | 787 per 1000 (497 to 1000) | |||||
| Moderate | ||||||
| 318 per 1000 | 629 per 1000 (397 to 994) | |||||
| Remission at 3 to 6 months: complete remission | Study population | RR 3.43 (1.84 to 6.41) | 156 (2) | ⊕⊕⊝⊝ LOW 1 2 | ||
| 128 per 1000 | 440 per 1000 (236 to 822) | |||||
| Moderate | ||||||
| 103 per 1000 | 354 per 1000 (190 to 662) | |||||
| Remission at 3 to 6 months: partial remission | Study population | RR 1.68 (0.43 to 6.56) | 156 (2) | ⊕⊝⊝⊝ VERY LOW 1 2 3 | ||
| 269 per 1000 | 452 per 1000 (116 to 1000) | |||||
| Moderate | ||||||
| 215 per 1000 | 361 per 1000 (92 to 1000) | |||||
| Adverse events: treatment failure (non response, serious infection, persistently elevated creatinine) at 6 months | Study population | RR 0.32 (0.18 to 0.58) | 124 (1) | ⊕⊕⊕⊝ MODERATE 4 | ||
| 541 per 1000 | 173 per 1000 (97 to 314) | |||||
| Moderate | ||||||
| 541 per 1000 | 173 per 1000 (97 to 314) | |||||
| Adverse events: medications ceased due to adverse events | Study population | RR 0.20 (0.04 to 0.86) | 131 (1) | ⊕⊕⊕⊝ MODERATE 4 | ||
| 154 per 1000 | 31 per 1000 (6 to 132) | |||||
| Moderate | ||||||
| 154 per 1000 | 31 per 1000 (6 to 132) | |||||
| Adverse events: serious infections | Study population | RR 0.49 (0.16 to 1.56) | 131 (1) | ⊕⊕⊕⊝ MODERATE 4 | ||
| 123 per 1000 | 60 per 1000 (20 to 192) | |||||
| Moderate | ||||||
| 123 per 1000 | 60 per 1000 (20 to 192) | |||||
| Adverse events: death | Study population | RR 0.33 (0.01 to 7.92) | 131 (1) | ⊕⊕⊝⊝ LOW 4 | ||
| 15 per 1000 | 5 per 1000 (0 to 122) | |||||
| Moderate | ||||||
| 15 per 1000 | 5 per 1000 (0 to 122) | |||||
| *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Small patient numbers and events
2 High risk of attrition bias in one study
3 Heterogeneity between studies
4 Single study; small patient numbers and events